Reassessing Patterns of Response to Immunotherapy with PET: From                     Morphology to Metabolism

Costa, Larissa Bastos; Queiroz, Marcelo A.; Barbosa, Felipe de Galiza; Nunes, Rafael Fernandes; Zaniboni, Elaine C.; Ruiz, Mariana Mazo; Jardim, Denis Leonardo Fontes; Marin, José Flávio Gomes; Cerri, Giovanni Guido; Buchpiguel, Carlos Alberto

doi:10.1148/rg.2021200093

Cited by 32 publications

(65 citation statements)

References 79 publications

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“…It can be explained through enhancing antitumor immune response by ICIs that can alter immunologic homeostasis up to break self-tolerance and develop autoimmune disease, virtually involving any organ [75]. IrAE can occur at any time during ICI therapy, but is common within the first 3 months [76]. Since not all IrAEs exhibit clinical signs and symptoms, 18F-FDG PET/CT could provide more information on IrAEs, even before they become manifest.…”

Section: Role Of 18f-fdg Pet/ct In Iraesmentioning

confidence: 99%

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Early Evaluation of Immunotherapy Response in Lymphoma Patients by 18F-FDG PET/CT: A Literature Overview

Ferrari

Maggialetti

Masi

et al. 2021

JPM

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Immunotherapy is a promising therapeutic strategy both for solid and hematologic tumors, such as in Hodgkin (HL) and non-Hodgkin lymphoma (NHL). In particular, immune-checkpoint inhibitors, such as nivolumab and pembrolizumab, are increasingly used for the treatment of refractory/relapsed HL. At the same time, evidence of chimeric antigen receptor (CAR)-T-cell immunotherapy efficacy mostly in NHL is growing. In this setting, the challenge is to identify an appropriate imaging method to evaluate immunotherapy response. The role of 18F-Fluorodeoxyglucose (18F-FDG) positron-emission tomography/computed tomography (PET/CT), especially in early evaluation, is under investigation in order to guide therapeutic strategies, taking into account the possible atypical responses (hyperprogression and pseudoprogression) and immune-related adverse events that could appear on PET images. Herein, we aimed to present a critical overview about the role of 18F-FDG PET/CT in evaluating treatment response to immunotherapy in lymphoma patients.

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Section: Role Of 18f-fdg Pet/ct In Iraesmentioning

confidence: 99%

“…For example, pneumonitis, a common IrAE, appears at PET/CT with different intensities of FDG-uptake associated with reactive mediastinal lymphadenopathy and possibly pleural effusions. CT specific imaging patterns (ground-glass opacities and consolidations) can clarify the diagnostic doubt [76].…”

Section: Role Of 18f-fdg Pet/ct In Iraesmentioning

confidence: 99%

Early Evaluation of Immunotherapy Response in Lymphoma Patients by 18F-FDG PET/CT: A Literature Overview

Ferrari

Maggialetti

Masi

et al. 2021

JPM

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“…In NSCLC, both anatomic evaluation with contrast-enhanced (ce)-CT and metabolic evaluation with 2-deoxy-2-[ 18F]fluoro-D-glucose ([18F]FDG) PET/CT are essential for patient's staging and management [112][113][114]. [18F]FDG has already reached a pivotal role in NSCLC, being used routinely to evaluate tumor metabolism in NSCLC patients at staging [115][116][117]. Although guidelines do not support the use of serial [18F]FDG PET/CT in NSCLC patients treated with ICIs in clinical practice, several studies are highlighting the potential role of metabolic information in both predictive (at baseline PET) and prognostic (at interim evaluation or time to radiological progression) perspectives.…”

Section: In-vivo Biomarkers For Immunotherapy: Molecular Imagingmentioning

confidence: 99%

NSCLC Biomarkers to Predict Response to Immunotherapy with Checkpoint Inhibitors (ICI): From the Cells to in-Vivo Images

Liberini

Mariniello

Righi

et al. 2021

Preprint

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Lung cancer remains the leading cause of cancer-related death and it is usually diagnosed in advanced stages (stage III or IV). Recently, the availability of targeted strategies and of immunotherapy with checkpoint inhibitors (ICI) has favorably changed patient prognosis. Treatment outcome is closely related to tumor biology and interaction with the host immune microenvironment (TME). Whether for targeted therapies the response relies on the presence of specific genetic alterations in tumor cells, for ICI accurate biomarkers of response are lacking and clinical outcome likely depends on multiple factors, host and tumor-related. This paper is an overview of the ongoing research on predictive factors both from in-vitro/ex-vivo analysis (ranging from conventional pathology to molecular biology) and in-vivo analysis, where molecular imaging is showing an exponential growth and use due to the technological advancement and to the new bioinformatics approaches applied to image analyses that allow specific features recovery in specific tumor subclones.

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“…In the functional criteria, the indeterminate response, related to the immune-mediated flare effect, has been introduced also in imPERCIST, PERCIMT and LYRIC criteria. Moreover, the complete disappearance of [ 18 F]FDG uptake in all lesions means a complete metabolic response, regardless of a change in tumor size (in contrast to morphological criteria) [143]. Finally, with the intent of differentiating pseudo-progression from true progression, PERCIMT introduced also new criteria of progressive disease (PD), such as the appearance of four or more new lesions (< 1.0 cm in functional diameter), or three or more new lesions (> 1.0 cm in functional diameter) or two or more new lesions (> 1.5 cm in functional diameter) [139].…”

Section: Functionalmentioning

confidence: 99%

“…Compared with morphologic imaging, [ 18 F]FDG PET/CT has also the advantage of an early detection of autoimmune reactions and irAEs (such as hypophysitis, pneumonia, colitis, hepatitis, and thyroiditis) due to increased uptake of [ 18 F]FDG at these sites. This potentially allows for a rapid intervention in life-threatening cases, and aides in switching therapy in less severe cases [143].…”

Section: Functionalmentioning

confidence: 99%

Molecular Imaging in Immunotherapy: A Systematic Review

Liberini¹,

Laudicella²,

Capozza³

et al. 2021

Preprint

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Immunotherapy is an effective therapeutic option for several cancers. In the last years, the introduction of checkpoint inhibitors (ICIs) has shifted the therapeutic landscape in oncology and improved patient prognosis in a variety of neoplastic diseases. However, to date, the selection of the best patients eligible for these therapies, as well as the response assessment is still challenging. Patients are mainly stratified using immunohistochemical analysis of the expression of anti-gens on biopsy specimens, such as PD-L1 and PD-1, on tumor cells, on peritumoral immune cells, and/or in the tumor microenvironment (TME). Recently, the use and development of imaging biomarkers able to assess in-vivo cancer-related processes are becoming more important. Today, positron emission tomography (PET) with 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) is used routinely to evaluate tumor metabolism, and also to predict and monitor response to immunotherapy. Although highly sensitive, FDG-PET, in general, is rather unspecific. Novel radiopharmaceuticals (immuno-PET radiotracers) able to identify specific immune system targets are under investigation in pre-clinical and clinical settings. In this review, we will provide an overview of the main new immuno-PET radiotracers in development. We will also review the main players (immune cells, tumor cells, and molecular targets) involved in immunotherapy. Furthermore, we report current applications and the evidence of using [18F]FDG PET in immunotherapy, including the use of artificial intelligence (AI).

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Reassessing Patterns of Response to Immunotherapy with PET: From Morphology to Metabolism

Cited by 32 publications

References 79 publications

Early Evaluation of Immunotherapy Response in Lymphoma Patients by 18F-FDG PET/CT: A Literature Overview

Early Evaluation of Immunotherapy Response in Lymphoma Patients by 18F-FDG PET/CT: A Literature Overview

NSCLC Biomarkers to Predict Response to Immunotherapy with Checkpoint Inhibitors (ICI): From the Cells to in-Vivo Images

Molecular Imaging in Immunotherapy: A Systematic Review

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